Hard Pill To Swallow: Mapping A Response to the Opioid Crisis

In the last several weeks, it was announced that people in the United States are now more likely to die from an opioid overdose than from a car accident. While this revelation is staggering, the opioid and overdose crisis in the US has been building for some time, claiming the lives of over 200 people per day according to US government tracking, and impacting communities across the country. Wanting to know more about the growing crisis, how the State is both responding to it in rhetoric as well as policy, and how communities are responding on a grassroots and autonomous level, we caught up with Codi, an anarchist and someone that works with people in recovery as an opioid specialist, on top of being someone with an intimate understanding of the crisis from her own lived experiences.

Drug overdose deaths in the US topped 72,000 in 2017, according to new provisional estimates released by the Centers for Disease Control and Prevention (CDC). This staggering figure translates into about 200 drug overdose deaths every day, or about one every eight minutes. The new CDC estimates are 6,000 deaths more than 2016 estimates, a rise of 9.5 percent.

Opioid overdoses increased 30 percent from July 2016 through September 2017 in 52 areas in 45 states. The Midwestern region saw opioid overdoses increase 70 percent from July 2016 through September 2017.

[T]he three companies involved in the distribution of opioids in Missouri and across the country reaped extraordinary profits. According to the report,“[E]ach recorded 2017 revenue in excess of $125 billion and ranked within the top 15 companies on the 2017 Fortune 500 list.”

As the crisis has grown, politicians in both parties have jumped at the opportunity to use it as a talking point in recent political campaigns, however have largely done nothing to offer tangible aid to those in desperate need of programs and support. Legislation passed in the September of 2018 focused largely on more money for law enforcement and not on recovery.

This means billions for police to become further militarized along with more people in prison, and in the case of cities like Baltimore, an epicenter of drug sales that supply rural regions such as in the nearby Virginas, in means police in a wide area attempting to crack down against largely black communities, in response to a rise in opioid overdoses in what are often largely working and middle class white communities. Trump (and Democrats) have also used the threat of the importation of drugs like fentanyl to call for the drastic militarization of the US/Mexico border.

While this ‘tough on crime’ response mirrors that of the State’s answer to the crack-cocaine epidemic that destroyed African-American communities (largely due to the US government flooding them with drugs in order to raise money to send the anti-Communist ‘Contras’), the fact that it is being referred to at all as a crisis that needs to be combated it evident that so many white people are dying of overdoses.

This contradiction lays bare the inability of the State to address the overdose crisis across the board and shows that its only interest is in maintaining an increasing level of counter-insurgency against the poor broadly but against black and brown populations specifically. Ultimately, such policies seek to play on the fears of reactionary white workers, but in the end offer no tangible benefits or solutions to the crisis at hand, other than the knowledge that police are kicking in less doors of whites than they are African-Americans or Latinos.

The crisis also highlights other realities and contradictions of American capitalism: a medical industry more interested in profit than human lives, an economic system that produces sick and injured people in need of medication to be able to function, and a government that sees a drug crisis as an opportunity to increase counter-insurgency techniques and mass incarceration.

With these realities in mind, we end our conversation by discussing what a grassroots, community based, and autonomous response to the crisis might begin to look like. Using the concepts of harm-reduction and programs like needle-exchange as a reference point, we flesh out these ideas, while talking about basic things that people can begin to do, like attending trainings on overdose prevention and learning to use the overdose prevention drug, Narcan.

You're absolutely right. As usual, the staggering size and complexity of the combined forces of the state, capitalists, and NGOs means there's really no way to engage with this without their assistance and/or permission. This is by design, of course, but pointing that out doesn't help anyone. This is an endlessly frustrating state of affairs. There are places where individuals or groups can help. For example some users don't trust or can't get to clinics that give out naloxone (narcan) so you can go there and get some yourself then give it to people who need it. This seems worthwhile to do but should not be seen as outside of leviathan in any way.

There are biohackers that figured out how to make naloxone from oxycodone, though that seems like it's a long LONG way from being a practical solution. The only worthwhile practical thing I can see helping at all is kratom, which is effective as a safe, low cost replacement for mild to moderate opioid habits, though it will be illegal or at least inaccessible within a few years.

Id say naloxone is dreaming big. There's a few places where anarchists are involved in harm reduction. I wonder how many people are alive or healthier than they'd otherwise be. I'm not sure if you're suggesting otherwise or not, but reversing overdoses is pretty big.

programs can lead addicts to other resources like detox, rehab and recovery. By establishing a rapport you can win their confidence and offer them alternatives to their current lifestyle. AIDS and other communicable diseases put a big damper on the sexual revolution so there are some indirect benefits to reducing the spread of disease and it's also good public relations for marginalized politicos.

16:25 this has been said elsewhere in this thread, but doesn't this just risk falling into the food not bombs hole of service provision as anarchy? it's definitely a nice feeling to think you've saved a life or helped that person to live better, but your role vis a vis the people you're helping is likely to be that of a nonprofit with much less resources and a nicer attitude, though probably with a stronger "serve the people" chip on your shoulder. The person in the interview is a nonprofit worker who happens to be an anarchist, which is why she has nothing particularly interesting to say about service provision that differs from the nonprofit work that she's doing.

There's a lot of different models for this tho. In communities where the crisis is very concentrated in a small region, they've literally started distributing naloxone kits to random everybody, users, social workers of all types, anyone who sits through the hour long training.

I think we can safely say, at this point, that it's strange to break out the arch-individualist argument and swing your ideology machete at anyone with a naloxone kit, calling them a goody goody who's helping the state or whatever. I mean, feel free to be as big of a dickhead as you really feel is necessary here and I'll be sneering at ya from my corner and we'll just never agree about what debates are worth having.

No one wants to know about the misuse of naloxone though, it is a very dangerous drug which can send a non opiod user into a severe psychotic reaction.
Methadone programs on the other hand worked okay for many addicts.

I know it reliably produces dysphoria so that makes sense. The funniest shit is how cops are always taking naloxone because they had a panic attack after finding powder in someone's pocket. "I think I inhaled some! Hit me!" They love that shit.

They thrive on paranoia and aggression because they are wired opposite to calm sane opium addicts. Thrill seeking adrenaline addicts are worshipped as heroes by the capitalists because they are part of the spectacle. Leep before looking is part of the whole economic scheme, reep unsustainably, overfish before replenishment, copulate excessively before overpopulation etc. All these hyped up adrenal, steroid and processed sugar cultural pursuits of hysterical exhibitionism is meritorious, but the quiet humble and meditative dope addict is scorned and vilified, and incarcerated.

I'm not sure why you're throwing the "edgier than thou" stuff at me - i don't see many people (myself included) swinging machetes here. It's nice to hear there are at least potentially more interesting models than the one featured in the interview - maybe IGD could have found one of those instead of talking to someone about their nonprofit work.

My point is that projects like this are predictable and tend to lack creativity or much conflict with the existing world beyond, again, just trying to be a better nonprofit. People see a Big Problem, try to do something to change it, and get so wrapped up in the mess that is trying to staunch the wounds of masses of random strangers who are suffering while also appearing like normies with an attitude so they're not too threatening to their target audience that the anarchist nature of the project disappears and they just end up building something that either evaporates quietly once its run its course/people have gotten sufficiently burned out or gets subsumed within the big boy nonprofit world like Common Ground. Having participated in that kind of dynamic, it's frustrating and a bad way to do projects imo.

I'm not being "edgy", I'm challenging your critique as lacking much substance.

It's always challenging to keep track of anon discussion but a lot of the critiques here don't really seem to be saying much IMO. You don't like how harm reduction has practical limitations? Who does? Why would we?

What's the alternative? Burn-out means go do something else. Doesn't mean you then argue that nobody should do harm reduction tho.

The state and charities do this. it's depressing that this is what the self identified anarchists are looking too. if they want to be social workers then why not just go do that? The Rest of us will be out breaking things.

First, Crimethinc stopped Donald Trump, now IGDscouts will dismantle big pharma. I love the insurractivist mentality that there can (and must) be an anarchist "response" to every geopolitical machination and systemic issue. Y'all are like a lone chihuahua trying to pick fight after fight with a pack of rabid pitbulls (usually from inside a fenced yard). Yeah it's kinda cute but mostly it's sad. "Let me at 'em!"

Im not sure I agree with this low key anarcho-puritanism. Most of my friends are in the milieu. The media I have access to is within the milieu. So if I were involved directly in harm reduction, Id approach it as an anarchist and if I wanted to talk about it in media Id probably end up doing so with anarchists.

I don't feel that charity acts like this and FNB are inherently anarchist or that they're some form of prefiguration, regardless of the mental gymnastics used to insist theyre mutual aid. I still think they're worthwhile. But this idea that anarchism needs to be a pure idea that we compartmentalize from other things we do is a bit strange to me.

Should we not have other interests? Is it that we should not allow our anarchist self and our syringe access self to ever cross over? Must we always clarify when things dont totally fit into anarchism?

Should anarchist publishers always include a thing about how their projects are capitalist and work? They know the complexities. Should anarchists doing charitable work always clarify that their projects aren't perfectly anarchist? I think these things go without saying. Whenever I've had these convos people have understood the complexities.

Theres always an "anarchist response" because there is always anarchists doing things outside of anarchy.

Honestly, since when are anarchists gullible enough to swallow every mainstream media talking point like this? People are taking drugs, so what's the problem? Its their own goddamn business. The only "crisis" here is that we live in a society where people feel it is their right or their duty to interfere in the personal choices of others, whether in a legalistic or "humanitarian" way, or some combination thereof. Quit jumping on the social cause bandwagon, and stop acting like a bunch of old-fashioned temperance preachers.

Sigh ... I didn't "buy in to" anything. That's just bullshit conjecture by the previous poster.

What I am willing to do is use the word "crisis" because that's not just a "media talking point", it's math. It's based on verifiable data and linked to the prevailing economic conditions along with systemic shady business practices by big pharma.

It has zero to do with me interfering with people's drug use, I have no desire or ability to do that. But it sure is dumb to lump all these issues together as "Puritanism" tho!

Nope, I've got more experience than you with the effects of drug abuse. There is, however, no "social crisis" going on, other than the one manufactured by the mainstream mediia, and now being perpetuated uncritically on an anarchist web site. People have a right to take drugs and enjoy themselves, or they have a right to take drugs and kill themselves. The last thing the anarchist milieu needs is this kind of self-righteous posturing, which only strengthens the authoritarian tendencies in our world.

That person can't be bothered to read and just keeps insisting harm reduction is the same as prohibition ideology … pretty soon I'll start making jokes about how at least some of us haven't done enough drugs to turn our brains to mush (yet)

Treat the substance as a yogic tool, learn to control and channel the anger away from the self-destructive and make life euphoric WITHOUT the drug. There will be times when you're hooked, like cigarettes, but one persists and presto, you're cured and high without any drugs.
There is nothing so weary as seeing old 30s something junkies who didn't have the nous to grasp the essential lessons the drug was showing them, and learning the technique to attain that high without the drug, as I have attained.

A breakdown of communal bounds, an accelerated and longer day life pace leads to people needing to have something to "cope". Amerika is great in creating drugs, guns, and lawyers. Sorry to see people suffer. But IMHO, anarchists should focus their attention in world-building elsewhere.

Homeostasis. The organism always seeks it. What cannot be obtained as easily when the substance is blocked and dosages aren't adjustable. *Full Legalization.* Where is comes from Afghanistan?, a nation of addicts? Or where its shipped through like Mexico Columbia wherever, cheap and a low ratio of cops to proles to dragnet shake down every guy and girl. Nah. It sound be administered freely to the milligram with antidotes on hand. Nature takes it's course and has it's own logic. The prohibitions are a power play, disguised as public health. Hubris. They are not foundational either as Lincoln remarked, making crimes of acts which are not crimes.

Isn't there also a type of social homeostasis represented by drug cartels, showing the lack of political agency when up against mass neurochemistry? Piles of bodies in it's wake. Armies and police can do little, always corrupted, bypassed, met with surprising retaliatory force, punishments accepted and ignored. And there's nothing that will bring some humanist reason into play to stop all this. Legalization shall not be allowed. These are the games that people like to play.

Narcan is really expensive, so I don't see that as a reasonable option. Kratom is a useful substance that can help heroin junkies get off of heroin and/or not get sick from withdrawal. Plus it's relatively inexpensive and one can't overdose from.

They serve two entirely different functions. Kratom is not an "option" for reversing overdose. It does help with withdraws. So maybe after you administer naloxone you should feed your newly dope sick and conscious friend some kratom.

Like what I said before, don't accidentally give naloxone to a withdrawing doper or they will spiral into a dangerous psychotic/physiological crisis. Why perpetuate the binary struggle, just have opium dens everywhere and liberate people from the authoritarian dream police.

Actually, from personal experience years ago when I had developed a happy tolerance to opiods from a positive disciplined use of them to develop yogic skills, a friend handed me some without my knowledge in an ampoule. Haha, you know the cover to Black Sabbath's Paranoid, well that pink guy with the sword was flying around my bed TRYING TO KILL ME !